But the experience of 1918 also reminds us that early, layered (i.e., more than one at the same time) and lengthy mitigation measures are the best strategy. For social distancing to work, it must be sweeping and enforced across a wide swath of the community. Essential businesses will, of course, need to continue. All other places where people congregate should cease operations for the time being. In 1918, social distancing measures were kept in place for many weeks, if not months, even if people and businesses did not always support them. But the key lesson: This approach worked.
By now, many have read of the comparisons between St. Louis, where a decisive health commissioner reacted with amazing rapidity to implement sweeping public health orders, and Philadelphia, which chose to stay open, even going ahead with plans for a huge parade.
St. Louis was rewarded with one of the best outcomes of any large U.S. city. Philadelphia’s fateful decision to carry on with its immense Liberty Loan Parade resulted in a massive spike in influenza cases in the days immediately following. The city endured some of the worst numbers of cases and deaths in the United States as a result.
Philadelphia was hardly alone, however. In Baltimore, the health commissioner dragged his feet when a group of physicians requested that the city ban public gatherings. “We do not consider such drastic steps necessary in view of the extreme low civilian death rate in the city,” he told them. More than 4,100 Baltimoreans lost their lives to the epidemic.
In Atlanta, the mayor sided with business interests and reopened the city after just three weeks of closures, over the vocal objections of his Board of Health. When the board predicted that Atlanta’s epidemic peak would not occur for another nine days, the mayor dismissed the science, arguing that there was no way to foretell future conditions. The city health officer sided with the mayor, mistakenly declaring that the peak had passed. It had not, and Atlanta’s fall wave of the epidemic raged on, unchecked, through the end of 1918. “The influenza situation in Atlanta is up to the people themselves,” the Public Safety Committee declared.
Atlanta may be a more extreme example, but its experience was hardly singular. In every city we studied from this era there was public pressure to quit the social distancing measures as soon as the epidemic seemed to peak and then ebb. Thinking that the proverbial coast was clear, many communities lifted social distancing measures before the battle was truly over. After weeks of being denied their usual social outlets, people were eager to return to a life of normalcy, and they did so in one giant rush. In city after city, masses lined up for movie houses and performance theaters, crowds packed into dance halls and cabarets, and throngs flocked to downtown shopping districts, often on the very day that the closure orders were lifted.
The result? Cases and deaths resurged. Most cities closed their schools once again. But the political, economic and social will to issue another round of sweeping business closures and gathering bans had evaporated as people grew weary of the dislocations of social distancing. In some cities, most notably Denver, Kansas City, Milwaukee and even the vaunted St. Louis, this second peak was even deadlier than the first.